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Catecholamines and Estrogen Are Involved in the Pathogenesis of Emotional Stress‐induced Acute Heart Attack
Author(s) -
Ueyama Takashi,
Kasamatsu Ken,
Hano Takuzo,
Tsuruo Yoshihiro,
Ishikura Fuminobu
Publication year - 2008
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1196/annals.1410.079
Subject(s) - endocrinology , medicine , sympathetic nervous system , estrogen , autonomic nervous system , cardiomyopathy , cardiac function curve , nervous system , heart failure , heart rate , blood pressure , psychiatry
Emotional stress triggers takotsubo cardiomyopathy in postmenopausal women. Clinical analysis of autonomic nervous function has revealed a transient increase of sympathetic nervous activity and decrease of vagal nervous activity. Immobilization (IMO) stress of rats can reproduce the electrocardiographic and left ventriculographic changes that occur in takotsubo cardiomyopathy, both of which are prevented by combined blockade of α‐ and β‐adrenoceptors. Estrogen supplementation partially attenuated these cardiac changes. It also attenuated the IMO‐induced increase of c‐Fos immunoreactivity, or c‐fos mRNA expression in the lateral septum, medial amygdaloid nucleus, paraventricular hypothalamic nucleus, dorsomedial hypothalamic nucleus, laterodorsal tegmental nucleus, and locus ceruleus; these regions contain central sympathetic neurons and neurons with immunoreactive estrogen receptors. It also downregulated c‐fos mRNA expression in the adrenal gland and the heart, suggesting an increase of estrogen attenuated the stress‐induced hypothalamo‐sympathoadrenal outflow from the central nervous system to the target organs. Estrogen treatment also upregulated the levels of cardioprotective substances, such as atrial natriuretic peptide and heat shock protein 70, in the heart. These data suggest that reduction of estrogen levels following menopause might be involved in the primary cause of takotsubo cardiomyopathy both by indirect action on the nervous system and by direct action on the heart.